Adati Tarfa, Kristen Pecanac, Olayinka Shiyanbola, Cameron Liebert, Sarah Dietz, Rebecca Miller, Ryan P Westergaard
Background: People living with HIV and substance use disorders (SUDs) have complex health care needs requiring adaptive and effective support systems. While mobile health apps can foster virtual communities grounded in shared lived experiences, little is known about the dynamics within these digital spaces.
Objective: We examined the formation of a virtual community on the Addiction Comprehensive Health Enhancement Support System (A-CHESS; The Center for Health Enhancement Systems Studies, University of Wisconsin-Madison College of Engineering) message board, a mobile app designed to support HIV care engagement among individuals living with HIV and SUD.
Methods: We conducted a computer-mediated discourse analysis of A-CHESS message board posts to examine communication patterns, interaction structures, and engagement dynamics. Quantitative comparisons were used to assess differences between posters and nonposters using t tests and chi-square tests. We then applied qualitative coding to categorize messages by type, speaker, and function to understand how staff and participants coconstructed a supportive virtual environment.
Results: Among 208 participants, 87 (42%) posted at least once on the A-CHESS message board, contributing 1834 messages between April 2019 and May 2021. Posters and nonposters did not differ significantly in age (t206=-0.64; P=.52), gender (χ²1=0.14; P=.71), or race (χ²1=0.52; P=.47). We identified 3 message types: premeditated, adlib, and participant-driven. Staff initially led with premeditated messages (eg, recovery stories, HIV risk information, and "Thought of the Day" inspiration), which participants often interpreted and adapted to their own SUD recovery. Over time, staff incorporated adlib messaging styles using personalized narratives and polls to sustain engagement. Participants then developed their own posts using similar formats, incorporating Alcoholics Anonymous literature, sharing legal and personal challenges, and suggesting new app features (eg, medication check-ins to support adherence).
Conclusions: A-CHESS staff adapted communication styles to increase engagement, while participants appropriated the app's message board to reflect personal goals and lived experiences. Mobile health interventions may benefit from design elements that support participant-led discourse and customization, fostering ownership, support, and relevance within virtual care communities.
{"title":"Support Community Formation on a Mobile App for People Living With HIV and Substance Use Disorder: A Computer-Mediated Discourse Analysis.","authors":"Adati Tarfa, Kristen Pecanac, Olayinka Shiyanbola, Cameron Liebert, Sarah Dietz, Rebecca Miller, Ryan P Westergaard","doi":"10.2196/66564","DOIUrl":"10.2196/66564","url":null,"abstract":"<p><strong>Background: </strong>People living with HIV and substance use disorders (SUDs) have complex health care needs requiring adaptive and effective support systems. While mobile health apps can foster virtual communities grounded in shared lived experiences, little is known about the dynamics within these digital spaces.</p><p><strong>Objective: </strong>We examined the formation of a virtual community on the Addiction Comprehensive Health Enhancement Support System (A-CHESS; The Center for Health Enhancement Systems Studies, University of Wisconsin-Madison College of Engineering) message board, a mobile app designed to support HIV care engagement among individuals living with HIV and SUD.</p><p><strong>Methods: </strong>We conducted a computer-mediated discourse analysis of A-CHESS message board posts to examine communication patterns, interaction structures, and engagement dynamics. Quantitative comparisons were used to assess differences between posters and nonposters using t tests and chi-square tests. We then applied qualitative coding to categorize messages by type, speaker, and function to understand how staff and participants coconstructed a supportive virtual environment.</p><p><strong>Results: </strong>Among 208 participants, 87 (42%) posted at least once on the A-CHESS message board, contributing 1834 messages between April 2019 and May 2021. Posters and nonposters did not differ significantly in age (t206=-0.64; P=.52), gender (χ²1=0.14; P=.71), or race (χ²1=0.52; P=.47). We identified 3 message types: premeditated, adlib, and participant-driven. Staff initially led with premeditated messages (eg, recovery stories, HIV risk information, and \"Thought of the Day\" inspiration), which participants often interpreted and adapted to their own SUD recovery. Over time, staff incorporated adlib messaging styles using personalized narratives and polls to sustain engagement. Participants then developed their own posts using similar formats, incorporating Alcoholics Anonymous literature, sharing legal and personal challenges, and suggesting new app features (eg, medication check-ins to support adherence).</p><p><strong>Conclusions: </strong>A-CHESS staff adapted communication styles to increase engagement, while participants appropriated the app's message board to reflect personal goals and lived experiences. Mobile health interventions may benefit from design elements that support participant-led discourse and customization, fostering ownership, support, and relevance within virtual care communities.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e66564"},"PeriodicalIF":2.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12807402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Troy Francis, Aleksandra Stanimirovic, Sonia Meerai, Nida Shahid, Valeria E Rac
<p><strong>Background: </strong>Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are responsible for a significant amount of the economic and chronic disease burden that impacts the Ontario health system. Telehomecare, a home self-management program launched by the Ontario Telemedicine Network (OTN), was created to improve access to quality care and limit health care use. However, few data are available on patient-, caregiver-, and provider-reported outcomes of telehomecare.</p><p><strong>Objective: </strong>This study aims to evaluate the impact of the OTN telehomecare program on the health-related quality of life (HRQoL), disease-management skills, and satisfaction of patients with HF and those with COPD; informal caregiver strain index; and nurse satisfaction with telehomecare.</p><p><strong>Methods: </strong>We used a prospective longitudinal cohort design, including patients with HF and those with COPD enrolled in Ontario's telehomecare program, informal caregivers of patients in the program, and nurses providing services in telehomecare. Patients and informal caregivers were administered telephone surveys at baseline, month 3, month 6, and month 12 follow-up from July 2016 to December 2019. The outcomes for the longitudinal surveys were patient-perceived HRQoL, disease self-management skills, perception of telehomecare (ease of use and usefulness), satisfaction with telehomecare, and informal caregiver-perceived strain. Cross-sectional surveys were conducted with nurses to assess nurse perception and satisfaction with telehomecare. Participant data were analyzed using general linear mixed models in SAS Statistical Software (version 9.4; SAS Institute Inc).</p><p><strong>Results: </strong>Overall, a total of 194 patients (HF, n=117; COPD, n=77), 62 caregivers, and 24 nurses participated, with an overall response rate of 51% (280/551). The average age of patients with HF and those with COPD was 71 (SD 11.3) years and 70 (SD 11.1) years, respectively, and 52% (100/194) were men. A significant improvement in overall HRQoL was observed among patients with HF at month 12 (-18.37, P<.001). Minimal clinically important differences were observed across all HRQoL domains for people with HF, indicating clinically meaningful improvement over the study period. No statistically significant improvement in HRQoL was observed among patients with COPD; however, minimal clinically important differences were observed in the physical functioning dimension. Patients reported being confident in self-managing their diseases throughout the study, but as patients aged, their perception of and satisfaction with telehomecare was shown to decrease (P=.002 and P=.002, respectively). Caregivers reported relatively low strain scores (mean 10.3, SD 5.9) throughout the program, and nurses reported moderate levels of satisfaction (mean 6.7, SD 1.5) with telehomecare at follow-up.</p><p><strong>Conclusions: </strong>In this population, telehomecare demonstr
背景：心力衰竭（HF）和慢性阻塞性肺疾病（COPD）是影响安大略省卫生系统的经济和慢性疾病负担的重要原因。远程家庭护理是安大略省远程医疗网络（OTN）发起的一项家庭自我管理计划，旨在改善获得高质量护理的机会并限制保健服务的使用。然而，很少有关于病人、护理者和提供者报告的远程家庭护理结果的数据。目的：本研究旨在评估OTN远程家庭护理计划对HF和COPD患者健康相关生活质量（HRQoL）、疾病管理技能和满意度的影响；非正式照顾者压力指数；以及护士对远程家庭护理的满意度。方法：我们采用前瞻性纵向队列设计，包括参加安大略省远程家庭护理计划的HF和COPD患者，该计划患者的非正式护理人员以及提供远程家庭护理服务的护士。在2016年7月至2019年12月的基线、第3个月、第6个月和第12个月随访期间，对患者和非正式护理人员进行电话调查。纵向调查的结果是患者感知的HRQoL、疾病自我管理技能、远程家庭护理的感知（易用性和有用性）、远程家庭护理的满意度和非正式护理者感知的压力。本研究以护士为对象，进行横断面调查，以评估护士对远程家庭护理的认知及满意度。使用SAS Statistical Software （version 9.4; SAS Institute Inc）中的一般线性混合模型分析参与者数据。结果：总体而言，共有194例患者（HF, n=117； COPD, n=77）， 62名护理人员和24名护士参与，总有效率为51%（280/551）。HF患者和COPD患者的平均年龄分别为71 （SD 11.3）岁和70 （SD 11.1）岁，男性占52%（100/194）。在HF患者中，在第12个月观察到总体HRQoL的显著改善（-18.37,p）。结论：在该人群中，远程家庭护理证明能够改善HF患者和COPD患者的HRQoL。然而，远程家庭护理后患者HRQoL改善的长期可持续性需要进一步调查。此外，远程家庭护理被证明可以减少非正式照顾者感知的压力，护士对远程家庭护理的满意度和感知的护理质量有中等水平。
{"title":"The Effect of Telehomecare on Patients' Health-Related Quality of Life, Satisfaction, Disease Self-Management Skills, Provider Satisfaction, and Informal Caregiver Strain: Longitudinal Cohort and Cross-Sectional Study.","authors":"Troy Francis, Aleksandra Stanimirovic, Sonia Meerai, Nida Shahid, Valeria E Rac","doi":"10.2196/70809","DOIUrl":"10.2196/70809","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are responsible for a significant amount of the economic and chronic disease burden that impacts the Ontario health system. Telehomecare, a home self-management program launched by the Ontario Telemedicine Network (OTN), was created to improve access to quality care and limit health care use. However, few data are available on patient-, caregiver-, and provider-reported outcomes of telehomecare.</p><p><strong>Objective: </strong>This study aims to evaluate the impact of the OTN telehomecare program on the health-related quality of life (HRQoL), disease-management skills, and satisfaction of patients with HF and those with COPD; informal caregiver strain index; and nurse satisfaction with telehomecare.</p><p><strong>Methods: </strong>We used a prospective longitudinal cohort design, including patients with HF and those with COPD enrolled in Ontario's telehomecare program, informal caregivers of patients in the program, and nurses providing services in telehomecare. Patients and informal caregivers were administered telephone surveys at baseline, month 3, month 6, and month 12 follow-up from July 2016 to December 2019. The outcomes for the longitudinal surveys were patient-perceived HRQoL, disease self-management skills, perception of telehomecare (ease of use and usefulness), satisfaction with telehomecare, and informal caregiver-perceived strain. Cross-sectional surveys were conducted with nurses to assess nurse perception and satisfaction with telehomecare. Participant data were analyzed using general linear mixed models in SAS Statistical Software (version 9.4; SAS Institute Inc).</p><p><strong>Results: </strong>Overall, a total of 194 patients (HF, n=117; COPD, n=77), 62 caregivers, and 24 nurses participated, with an overall response rate of 51% (280/551). The average age of patients with HF and those with COPD was 71 (SD 11.3) years and 70 (SD 11.1) years, respectively, and 52% (100/194) were men. A significant improvement in overall HRQoL was observed among patients with HF at month 12 (-18.37, P<.001). Minimal clinically important differences were observed across all HRQoL domains for people with HF, indicating clinically meaningful improvement over the study period. No statistically significant improvement in HRQoL was observed among patients with COPD; however, minimal clinically important differences were observed in the physical functioning dimension. Patients reported being confident in self-managing their diseases throughout the study, but as patients aged, their perception of and satisfaction with telehomecare was shown to decrease (P=.002 and P=.002, respectively). Caregivers reported relatively low strain scores (mean 10.3, SD 5.9) throughout the program, and nurses reported moderate levels of satisfaction (mean 6.7, SD 1.5) with telehomecare at follow-up.</p><p><strong>Conclusions: </strong>In this population, telehomecare demonstr","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e70809"},"PeriodicalIF":2.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naira Topooco, Philip Lindner, Claes Andersson, Petra Lindfors, Olof Molander, Martin Kraepelien, Christopher Sundström, George Vlaescu, Gerhard Andersson, Marcus Bendtsen, Anne H Berman
<p><strong>Background: </strong>University students show a high prevalence of diverse mental health problems, requiring adaptable interventions to assist them in improving their mental health.</p><p><strong>Objective: </strong>This study aimed to evaluate the feasibility of transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for anxiety and depression in preparation for a randomized controlled trial. ICBT incorporated 2 innovative approaches to increase precision: user-steered content personalization and within-treatment adaptive modification based on early symptom trajectory.</p><p><strong>Methods: </strong>This single-group, open-label study was conducted online in Sweden in the autumn of 2021, recruiting from students who had completed the World Health Organization (WHO) World Mental Health International College Student (WMH-ICS) mental health survey. Participants were eligible if they scored 5-19 on the Patient Health Questionnaire-9 (PHQ-9), or ≥5 on the Generalized Anxiety Disorder-7 (GAD-7), or both. Participants completed an 8-week ICBT program with therapist support. They initially personalized their program by selecting a primary problem orientation, anxiety or depression, and choosing additional elective modules, and could consult their therapist regarding these choices. At midtreatment, stepped care was piloted, in which participants without symptom improvement were randomized to adaptive enhancement of therapist support or to continue treatment as before. The main feasibility outcomes included data on reach and uptake, intervention acceptability, stepped care procedures, and assessment retention up to 6 months. The GAD-7 and PHQ-9 were the primary outcome measures, with changes in scores calculated using mixed effects models.</p><p><strong>Results: </strong>Of 749 invited students, 55 (7%) completed the study screening, and 28 (4%) were included. The GAD-7 baseline score was 9.5 (SD 4.4), and the PHQ-9 baseline score was 11.2 (SD 5.2). Participants opened 6.2 (SD 2.2) out of the 8 treatment modules. The user-directed personalization yielded 27 unique treatment configurations across 28 participants. At week 4, 16/27 (59%) participants remaining in treatment were randomized in the stepped care procedure. Ratings on self-report measures showed acceptable to good therapeutic alliance and treatment satisfaction. Eleven participants reported increased stress associated with the treatment. Reductions in depression and anxiety symptoms were observed at postmeasurement and 6 months follow-up, with 43% attrition at those times.</p><p><strong>Conclusions: </strong>This pioneering study of personalized ICBT with adaptive change among university students demonstrated the overall feasibility of the treatment. To enhance the design of a future definitive trial, modifications are necessary to mitigate assessment attrition and reduce treatment-related stress.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05509660
{"title":"Personalized Transdiagnostic Cognitive Behavior Therapy With Midtreatment Stepped Care to Improve Mental Health Among University Students in Sweden: Feasibility Study for a Randomized Controlled Trial.","authors":"Naira Topooco, Philip Lindner, Claes Andersson, Petra Lindfors, Olof Molander, Martin Kraepelien, Christopher Sundström, George Vlaescu, Gerhard Andersson, Marcus Bendtsen, Anne H Berman","doi":"10.2196/68698","DOIUrl":"10.2196/68698","url":null,"abstract":"<p><strong>Background: </strong>University students show a high prevalence of diverse mental health problems, requiring adaptable interventions to assist them in improving their mental health.</p><p><strong>Objective: </strong>This study aimed to evaluate the feasibility of transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for anxiety and depression in preparation for a randomized controlled trial. ICBT incorporated 2 innovative approaches to increase precision: user-steered content personalization and within-treatment adaptive modification based on early symptom trajectory.</p><p><strong>Methods: </strong>This single-group, open-label study was conducted online in Sweden in the autumn of 2021, recruiting from students who had completed the World Health Organization (WHO) World Mental Health International College Student (WMH-ICS) mental health survey. Participants were eligible if they scored 5-19 on the Patient Health Questionnaire-9 (PHQ-9), or ≥5 on the Generalized Anxiety Disorder-7 (GAD-7), or both. Participants completed an 8-week ICBT program with therapist support. They initially personalized their program by selecting a primary problem orientation, anxiety or depression, and choosing additional elective modules, and could consult their therapist regarding these choices. At midtreatment, stepped care was piloted, in which participants without symptom improvement were randomized to adaptive enhancement of therapist support or to continue treatment as before. The main feasibility outcomes included data on reach and uptake, intervention acceptability, stepped care procedures, and assessment retention up to 6 months. The GAD-7 and PHQ-9 were the primary outcome measures, with changes in scores calculated using mixed effects models.</p><p><strong>Results: </strong>Of 749 invited students, 55 (7%) completed the study screening, and 28 (4%) were included. The GAD-7 baseline score was 9.5 (SD 4.4), and the PHQ-9 baseline score was 11.2 (SD 5.2). Participants opened 6.2 (SD 2.2) out of the 8 treatment modules. The user-directed personalization yielded 27 unique treatment configurations across 28 participants. At week 4, 16/27 (59%) participants remaining in treatment were randomized in the stepped care procedure. Ratings on self-report measures showed acceptable to good therapeutic alliance and treatment satisfaction. Eleven participants reported increased stress associated with the treatment. Reductions in depression and anxiety symptoms were observed at postmeasurement and 6 months follow-up, with 43% attrition at those times.</p><p><strong>Conclusions: </strong>This pioneering study of personalized ICBT with adaptive change among university students demonstrated the overall feasibility of the treatment. To enhance the design of a future definitive trial, modifications are necessary to mitigate assessment attrition and reduce treatment-related stress.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05509660","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e68698"},"PeriodicalIF":2.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Kurilla, Natália Čavojská, Theresa Ikegwuonu, Marta Nemčíková, Julia Cc Schulte-Strathaus, Lotte Uyttebroek, Joanne R Beames, Dagmar Breznoščáková, Daniel Dančík, Michal Hajdúk, Anton Heretik, Ľubomíra Izáková, Zuzana Katreniaková, Inez Myin-Germeys, Ján Pečeňák, Ulrich Reininghaus, Anita Schick, Maria Wolters
Background: Mobile health tools that use the Experience Sampling Method (ESM) appear to be a promising tool to streamline and improve the treatment of substance use disorders. However, patient involvement in the development of these tools is uncommon, and research on the preferences of people being treated for substance use disorders has been scarce. In the scope of the European Union IMMERSE (Implementing Mobile Mental health Recording Strategy for Europe) consortium, an ESM-based tool for Digital Mobile Mental Health (DMMH) was first codeveloped and later tested in 4 European countries.
Objective: This study aimed to achieve an understanding of preferences for features of DMMH among mental health service users with problem substance use.
Methods: In 4 European countries, service users were recruited for a semistructured qualitative interview, which started with the presentation of a prototype of the DMMH. Data analysis was performed through directed qualitative content analysis.
Results: The analytical sample consisted of 12 (5 female, 6 male, and 1 nonbinary person) participants with problem substance use aged 18-50 years. There were 4 participants from Slovakia, 3 from Belgium, 4 from Germany, and 1 from Scotland. Patient preferences were classified into 7 categories: notifications, questions, user interface, functionality changes, visualizations, sharing data with clinicians, and sharing data with others. The proposed intensive notification schedule was deemed acceptable by service users as long as the questionnaire is short. Participants expressed a preference for open-text response options, Ecological Momentary Interventions, and options for individual customization of several elements of the tool. Data visualization was considered an important aid for communication with clinicians, with whom all participants wanted to share data obtained with DMMH. The possibility of sharing data with other people depended on the quality of the relationship with them.
Conclusions: In the development of ESM-based mobile health tools for people with problem substance use, their preferences for content, functionality, and appearance of the tools should be considered so they match patients' treatment needs.
{"title":"Preferences for an Experience Sampling Method-Based Tool as an Adjunct to Usual Treatment in Patients With Problem Substance Use: Qualitative Study.","authors":"Adam Kurilla, Natália Čavojská, Theresa Ikegwuonu, Marta Nemčíková, Julia Cc Schulte-Strathaus, Lotte Uyttebroek, Joanne R Beames, Dagmar Breznoščáková, Daniel Dančík, Michal Hajdúk, Anton Heretik, Ľubomíra Izáková, Zuzana Katreniaková, Inez Myin-Germeys, Ján Pečeňák, Ulrich Reininghaus, Anita Schick, Maria Wolters","doi":"10.2196/79510","DOIUrl":"10.2196/79510","url":null,"abstract":"<p><strong>Background: </strong>Mobile health tools that use the Experience Sampling Method (ESM) appear to be a promising tool to streamline and improve the treatment of substance use disorders. However, patient involvement in the development of these tools is uncommon, and research on the preferences of people being treated for substance use disorders has been scarce. In the scope of the European Union IMMERSE (Implementing Mobile Mental health Recording Strategy for Europe) consortium, an ESM-based tool for Digital Mobile Mental Health (DMMH) was first codeveloped and later tested in 4 European countries.</p><p><strong>Objective: </strong>This study aimed to achieve an understanding of preferences for features of DMMH among mental health service users with problem substance use.</p><p><strong>Methods: </strong>In 4 European countries, service users were recruited for a semistructured qualitative interview, which started with the presentation of a prototype of the DMMH. Data analysis was performed through directed qualitative content analysis.</p><p><strong>Results: </strong>The analytical sample consisted of 12 (5 female, 6 male, and 1 nonbinary person) participants with problem substance use aged 18-50 years. There were 4 participants from Slovakia, 3 from Belgium, 4 from Germany, and 1 from Scotland. Patient preferences were classified into 7 categories: notifications, questions, user interface, functionality changes, visualizations, sharing data with clinicians, and sharing data with others. The proposed intensive notification schedule was deemed acceptable by service users as long as the questionnaire is short. Participants expressed a preference for open-text response options, Ecological Momentary Interventions, and options for individual customization of several elements of the tool. Data visualization was considered an important aid for communication with clinicians, with whom all participants wanted to share data obtained with DMMH. The possibility of sharing data with other people depended on the quality of the relationship with them.</p><p><strong>Conclusions: </strong>In the development of ESM-based mobile health tools for people with problem substance use, their preferences for content, functionality, and appearance of the tools should be considered so they match patients' treatment needs.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e79510"},"PeriodicalIF":2.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Online harm affects many people and has been associated with self-harm and suicidal ideation. Although there is an emerging body of evidence that addressing adverse online experiences should be part of the support offered to people who are at risk of self-harm and suicide, there has been little guidance to date on how this support might be provided and how safe conversations can be had on the subject. A UK charity dedicated to offering emotional support to anyone experiencing mental discomfort, having difficulty coping, or being at risk of suicide developed a digital intervention, the Online Safety Hub (the Hub), to address this shortfall.
Objective: The study aimed to evaluate the impact of the Hub on practitioners (people who provide support) and people with lived experiences of suicide and self-harm and to determine what learning environment is best suited to increase and maintain learning in the context of the Hub.
Methods: A sequential explanatory mixed methods evaluation comprised a rapid literature review, data collected from people with lived experience (n=6) and practitioners through an analysis of the Hub's activity data, 2 surveys (survey 1: n=45; survey 2: n=368), interviews (n=9), and focus groups (n=7). Surveys were analyzed for descriptive purposes only, and the interview and focus group analyses comprised coding of data and thematic analysis. The study design was informed by a panel of people with lived experience of online harm resulting in either self-harm and/or suicidal ideation.
Results: Initially, the evaluation found limited uptake of the Hub. Engagement with the Hub was impeded by a lack of clarity on the part of practitioners as to whether they were the intended audience. The evaluation process prompted the charity to design and deliver webinars to facilitate uptake of the Hub. Practitioners who engaged with the Hub via webinars found the content useful and were able to consider incorporating their learning into practice. The webinars offered a more social learning experience than individual engagement with the Hub, providing a community of practice for people with common interests across diverse organizational settings. Opportunities for shared learning and the supportive nature of the community of practice were valued when learning about the sensitive and difficult topic of online harm in relation to self-harm and suicide. The Hub contributed to awareness-raising and shared learning.
Conclusions: Online resources alone may not be sufficient for an intervention to effectively raise awareness and change practice. Social learning facilitated through communities of practice can enhance engagement, uptake, and learning.
{"title":"Contribution of an Online Intervention to Developing Communities of Practice: Mixed Methods Evaluation of an Online Safety Hub to Address Harmful Online Content in Relation to Self-Harm and Suicide.","authors":"Arne Mueller, Gemma Hughes, Gregory Maniatopoulos","doi":"10.2196/72130","DOIUrl":"10.2196/72130","url":null,"abstract":"<p><strong>Background: </strong>Online harm affects many people and has been associated with self-harm and suicidal ideation. Although there is an emerging body of evidence that addressing adverse online experiences should be part of the support offered to people who are at risk of self-harm and suicide, there has been little guidance to date on how this support might be provided and how safe conversations can be had on the subject. A UK charity dedicated to offering emotional support to anyone experiencing mental discomfort, having difficulty coping, or being at risk of suicide developed a digital intervention, the Online Safety Hub (the Hub), to address this shortfall.</p><p><strong>Objective: </strong>The study aimed to evaluate the impact of the Hub on practitioners (people who provide support) and people with lived experiences of suicide and self-harm and to determine what learning environment is best suited to increase and maintain learning in the context of the Hub.</p><p><strong>Methods: </strong>A sequential explanatory mixed methods evaluation comprised a rapid literature review, data collected from people with lived experience (n=6) and practitioners through an analysis of the Hub's activity data, 2 surveys (survey 1: n=45; survey 2: n=368), interviews (n=9), and focus groups (n=7). Surveys were analyzed for descriptive purposes only, and the interview and focus group analyses comprised coding of data and thematic analysis. The study design was informed by a panel of people with lived experience of online harm resulting in either self-harm and/or suicidal ideation.</p><p><strong>Results: </strong>Initially, the evaluation found limited uptake of the Hub. Engagement with the Hub was impeded by a lack of clarity on the part of practitioners as to whether they were the intended audience. The evaluation process prompted the charity to design and deliver webinars to facilitate uptake of the Hub. Practitioners who engaged with the Hub via webinars found the content useful and were able to consider incorporating their learning into practice. The webinars offered a more social learning experience than individual engagement with the Hub, providing a community of practice for people with common interests across diverse organizational settings. Opportunities for shared learning and the supportive nature of the community of practice were valued when learning about the sensitive and difficult topic of online harm in relation to self-harm and suicide. The Hub contributed to awareness-raising and shared learning.</p><p><strong>Conclusions: </strong>Online resources alone may not be sufficient for an intervention to effectively raise awareness and change practice. Social learning facilitated through communities of practice can enhance engagement, uptake, and learning.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e72130"},"PeriodicalIF":2.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The evolution of language models, particularly large language models, has introduced transformative potential for psychological assessment, challenging traditional rating scale methods that have dominated clinical practice for over a century.
Objective: This study aimed to develop and validate an automated assessment paradigm that integrates natural language processing with conventional measurement tools to assess depressive symptoms, exploring its feasibility as a novel approach in psychological evaluation.
Methods: A cohort of 115 participants, including 28 (24.3%) individuals diagnosed with depression, completed the Beck Depression Inventory Fast Screen via a custom ChatGPT interface (BDI-FS-GPT) and the Chinese version of the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses included the Spearman correlation (PHQ-9 vs BDI-FS-GPT scores), Cohen κ (diagnostic agreement), and area under the curve (AUC) evaluation.
Results: Spearman analysis revealed a moderate correlation between PHQ-9 and BDI-FS-GPT scores. The Cohen κ indicated moderate diagnostic agreement between the PHQ-9 and the BDI-FS-GPT (κ=0.43; 76.5% agreement), substantial agreement between the BDI-FS-GPT and the clinical diagnosis (κ=0.72; 88.7% agreement), and moderate agreement between the PHQ-9 and the clinical diagnosis (κ=0.55; 71.4% agreement). The BDI-FS-GPT demonstrated excellent diagnostic accuracy (AUC=0.953) at a cutoff of 3, detecting 89.3% of participants with depression with an 11.5% false-positive rate compared to the PHQ-9 (AUC=0.859) at a cutoff of 5 (sensitivity=71.4%; false-positive rate=13.8%). Participants also reported significantly higher satisfaction with the automated assessment compared to the traditional scale (P=.02).
Conclusions: The automated assessment paradigm framework combines the interactivity and personalization of natural language processing-powered tools with the psychometric rigor of traditional scales, suggesting a preliminary feasibility paradigm for future psychological assessment. Its ability to enhance engagement while maintaining reliability and validity provides encouraging evidence, warranting validation in larger and more diverse studies as large language model technology advances.
International registered report identifier (irrid): RR2-10.1101/2024.07.19.24310543.
{"title":"Evaluating the Efficacy of AI-Based Interactive Assessments Using Large Language Models for Depression Screening: Development and Usability Study.","authors":"Zheng Jin, Jiaxing Hu, Dandan Bi, Kaibin Zhao, Huan Yu","doi":"10.2196/78401","DOIUrl":"10.2196/78401","url":null,"abstract":"<p><strong>Background: </strong>The evolution of language models, particularly large language models, has introduced transformative potential for psychological assessment, challenging traditional rating scale methods that have dominated clinical practice for over a century.</p><p><strong>Objective: </strong>This study aimed to develop and validate an automated assessment paradigm that integrates natural language processing with conventional measurement tools to assess depressive symptoms, exploring its feasibility as a novel approach in psychological evaluation.</p><p><strong>Methods: </strong>A cohort of 115 participants, including 28 (24.3%) individuals diagnosed with depression, completed the Beck Depression Inventory Fast Screen via a custom ChatGPT interface (BDI-FS-GPT) and the Chinese version of the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses included the Spearman correlation (PHQ-9 vs BDI-FS-GPT scores), Cohen κ (diagnostic agreement), and area under the curve (AUC) evaluation.</p><p><strong>Results: </strong>Spearman analysis revealed a moderate correlation between PHQ-9 and BDI-FS-GPT scores. The Cohen κ indicated moderate diagnostic agreement between the PHQ-9 and the BDI-FS-GPT (κ=0.43; 76.5% agreement), substantial agreement between the BDI-FS-GPT and the clinical diagnosis (κ=0.72; 88.7% agreement), and moderate agreement between the PHQ-9 and the clinical diagnosis (κ=0.55; 71.4% agreement). The BDI-FS-GPT demonstrated excellent diagnostic accuracy (AUC=0.953) at a cutoff of 3, detecting 89.3% of participants with depression with an 11.5% false-positive rate compared to the PHQ-9 (AUC=0.859) at a cutoff of 5 (sensitivity=71.4%; false-positive rate=13.8%). Participants also reported significantly higher satisfaction with the automated assessment compared to the traditional scale (P=.02).</p><p><strong>Conclusions: </strong>The automated assessment paradigm framework combines the interactivity and personalization of natural language processing-powered tools with the psychometric rigor of traditional scales, suggesting a preliminary feasibility paradigm for future psychological assessment. Its ability to enhance engagement while maintaining reliability and validity provides encouraging evidence, warranting validation in larger and more diverse studies as large language model technology advances.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.1101/2024.07.19.24310543.</p>","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e78401"},"PeriodicalIF":2.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krishnan Nayar, Vivian C Iloabuchi, Juliana M Kling, Bithika Thompson, Christopher Dodoo, Robert Horsley
<p><strong>Background: </strong>Transgender and gender-diverse (TGD) people experience greater health disparities than their cisgender counterparts. Social determinants of health are linked to these health disparities in minority communities, including the TGD community. Lack of social support contributes significantly to these disparities for the TGD community.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the role of social media and social support groups among TGD patients who attend a transgender clinic.</p><p><strong>Methods: </strong>A questionnaire was developed through an iterative process and emailed to TGD people attending a tertiary care TGD-focused clinic. The survey assessed social media use (platforms, duration, and adverse effects), social support groups (past participation and interest in current participation), and demographic characteristics (age, gender, race and ethnicity, educational level, religious affiliation, and income).</p><p><strong>Results: </strong>Our survey garnered 48 responses. Of these participants, 50% (n=24) identified as transfeminine or transgender women, 29.2% (n=14) identified as transmasculine or transgender men, 8.3% (n=4) identified as nonbinary, 2.1% (n=1) identified as genderfluid, and 10.4% (n=5) identified as another identity. Our respondents' average age was 35 (SD 15.6) years. Nearly 70% (n=31, 64.6%) reported at least monthly transphobia, and 35.4% (n=17) reported at least weekly transphobia. Primary social support was reported as coming from an in-person significant other or friend 49% (n=24) of the time and from social media or online friends 12.5% (n=6) of the time. Social media was used for the primary purpose of interacting with queer or TGD people by 65% (n=33) of respondents, and the most common sites used were Discord, Reddit, and Instagram. Among respondents who either were attending or had attended a gender identity-focused support group, 61% (14/23) reported them being beneficial. In total, 52% (25/48) had never attended a support group related to their gender identity, and 60% (15/23) were open to attending.</p><p><strong>Conclusions: </strong>This study found that social media is already being used by TGD people for the purpose of interacting with other queer and transgender people but also that there are risks associated with its use. Given this reality, counseling patients on social media use should focus on safety in use and honest discussions of both the risks and benefits associated with its use. Regarding social support groups focused on gender identity, many current or previous attendants reported that support groups were helpful for finding social support, especially early on in one's transition and when other avenues of support are not present. Additionally, many respondents who had never attended a support group were interested in attending for the perceived benefits of increased social support and interest in meeting other community members. Engag
{"title":"Survey Evaluation of the Role of Social Media and Social Support for Transgender, Nonbinary, and Intersex People: Observational Study.","authors":"Krishnan Nayar, Vivian C Iloabuchi, Juliana M Kling, Bithika Thompson, Christopher Dodoo, Robert Horsley","doi":"10.2196/79614","DOIUrl":"10.2196/79614","url":null,"abstract":"<p><strong>Background: </strong>Transgender and gender-diverse (TGD) people experience greater health disparities than their cisgender counterparts. Social determinants of health are linked to these health disparities in minority communities, including the TGD community. Lack of social support contributes significantly to these disparities for the TGD community.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the role of social media and social support groups among TGD patients who attend a transgender clinic.</p><p><strong>Methods: </strong>A questionnaire was developed through an iterative process and emailed to TGD people attending a tertiary care TGD-focused clinic. The survey assessed social media use (platforms, duration, and adverse effects), social support groups (past participation and interest in current participation), and demographic characteristics (age, gender, race and ethnicity, educational level, religious affiliation, and income).</p><p><strong>Results: </strong>Our survey garnered 48 responses. Of these participants, 50% (n=24) identified as transfeminine or transgender women, 29.2% (n=14) identified as transmasculine or transgender men, 8.3% (n=4) identified as nonbinary, 2.1% (n=1) identified as genderfluid, and 10.4% (n=5) identified as another identity. Our respondents' average age was 35 (SD 15.6) years. Nearly 70% (n=31, 64.6%) reported at least monthly transphobia, and 35.4% (n=17) reported at least weekly transphobia. Primary social support was reported as coming from an in-person significant other or friend 49% (n=24) of the time and from social media or online friends 12.5% (n=6) of the time. Social media was used for the primary purpose of interacting with queer or TGD people by 65% (n=33) of respondents, and the most common sites used were Discord, Reddit, and Instagram. Among respondents who either were attending or had attended a gender identity-focused support group, 61% (14/23) reported them being beneficial. In total, 52% (25/48) had never attended a support group related to their gender identity, and 60% (15/23) were open to attending.</p><p><strong>Conclusions: </strong>This study found that social media is already being used by TGD people for the purpose of interacting with other queer and transgender people but also that there are risks associated with its use. Given this reality, counseling patients on social media use should focus on safety in use and honest discussions of both the risks and benefits associated with its use. Regarding social support groups focused on gender identity, many current or previous attendants reported that support groups were helpful for finding social support, especially early on in one's transition and when other avenues of support are not present. Additionally, many respondents who had never attended a support group were interested in attending for the perceived benefits of increased social support and interest in meeting other community members. Engag","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e79614"},"PeriodicalIF":2.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia E Hershberger, Kirby Adlam, Mary B Richardson, Alison L Miller, Chelsea Fortin, Martha Driessnack, Harold D Grotevant, Susan C Klock, Lauri A Pasch, Agatha M Gallo
<p><strong>Background: </strong>Many parents who use donor-assisted conception to form their families struggle with telling their children about how they came to be. To address this problem, we created the Tool to Empower Parental Telling and Talking (TELL Tool), a digital, psychoeducational, and decision-support intervention for parents with children aged 1 to 16 years. Recently, we completed a pilot randomized controlled trial of the TELL Tool that showed feasibility, acceptability, and promise. However, in its current version, the TELL Tool does not include content for pregnant, expecting, or new parents with children less than 1 year of age.</p><p><strong>Objective: </strong>The aim of this formative study was to understand the views of pregnant, expecting, and new parents who used donor-assisted conception to form their families, along with the views of practicing clinicians about disclosure to expand the TELL Tool for use during the pregnant and early parenthood periods in the United States.</p><p><strong>Methods: </strong>Using a qualitative descriptive approach, a purposive sample of 20 parents and 10 practicing clinicians was recruited using a multifaceted recruitment plan. Each participant completed an in-depth, semistructured interview over Zoom that was recorded, auto-transcribed, checked for accuracy, and subsequently analyzed for themes. The rigorous and accelerated data reduction technique was incorporated into the analytic plan.</p><p><strong>Results: </strong>Parents comprised pregnant (n=6) or new parents (n=15), as one parent was both pregnant and had a child less than 24 months of age. The 10 clinicians, consisting of an array of multidisciplinary health care professionals, were practicing in fertility/infertility (n=4), obstetrics and women's health (n=3), and reproductive or family health (n=3) settings. Four themes were identified from the analysis. In "Reasons for What Matters Most," all parents spoke in favor of disclosing to their children and shared their reasons, while clinicians reported the time limitations in clinical settings. In "Managing Emotions, Conflicts, and Needs," a myriad of emotions, including conflict, were entwined in the parents' experiences, and clinicians recognized parents' feelings and needs as well as their own. Within "Desired Content of a Digital Tool," participants provided invaluable feedback on what material and content would be helpful to both parents and clinicians. Participants voiced the design features that would resonate or be useful to them or their patients/clients in "Recommended Design and Usability Features."</p><p><strong>Conclusions: </strong>Findings illustrate the distinct needs and desires of parents-to-be, new parents, and clinicians about providing expanded content for the TELL Tool that is informed by current evidence and end users, ultimately advancing best practices in this area. Future plans include testing the TELL Tool tailored to this additional developmental period o
{"title":"Expanding the Digital, Donor-Assisted Conception Tool to Empower Parental Telling and Talking (TELL Tool) Intervention to the Pregnant and Early Parenthood Periods: Findings From a Qualitative Study.","authors":"Patricia E Hershberger, Kirby Adlam, Mary B Richardson, Alison L Miller, Chelsea Fortin, Martha Driessnack, Harold D Grotevant, Susan C Klock, Lauri A Pasch, Agatha M Gallo","doi":"10.2196/79024","DOIUrl":"10.2196/79024","url":null,"abstract":"<p><strong>Background: </strong>Many parents who use donor-assisted conception to form their families struggle with telling their children about how they came to be. To address this problem, we created the Tool to Empower Parental Telling and Talking (TELL Tool), a digital, psychoeducational, and decision-support intervention for parents with children aged 1 to 16 years. Recently, we completed a pilot randomized controlled trial of the TELL Tool that showed feasibility, acceptability, and promise. However, in its current version, the TELL Tool does not include content for pregnant, expecting, or new parents with children less than 1 year of age.</p><p><strong>Objective: </strong>The aim of this formative study was to understand the views of pregnant, expecting, and new parents who used donor-assisted conception to form their families, along with the views of practicing clinicians about disclosure to expand the TELL Tool for use during the pregnant and early parenthood periods in the United States.</p><p><strong>Methods: </strong>Using a qualitative descriptive approach, a purposive sample of 20 parents and 10 practicing clinicians was recruited using a multifaceted recruitment plan. Each participant completed an in-depth, semistructured interview over Zoom that was recorded, auto-transcribed, checked for accuracy, and subsequently analyzed for themes. The rigorous and accelerated data reduction technique was incorporated into the analytic plan.</p><p><strong>Results: </strong>Parents comprised pregnant (n=6) or new parents (n=15), as one parent was both pregnant and had a child less than 24 months of age. The 10 clinicians, consisting of an array of multidisciplinary health care professionals, were practicing in fertility/infertility (n=4), obstetrics and women's health (n=3), and reproductive or family health (n=3) settings. Four themes were identified from the analysis. In \"Reasons for What Matters Most,\" all parents spoke in favor of disclosing to their children and shared their reasons, while clinicians reported the time limitations in clinical settings. In \"Managing Emotions, Conflicts, and Needs,\" a myriad of emotions, including conflict, were entwined in the parents' experiences, and clinicians recognized parents' feelings and needs as well as their own. Within \"Desired Content of a Digital Tool,\" participants provided invaluable feedback on what material and content would be helpful to both parents and clinicians. Participants voiced the design features that would resonate or be useful to them or their patients/clients in \"Recommended Design and Usability Features.\"</p><p><strong>Conclusions: </strong>Findings illustrate the distinct needs and desires of parents-to-be, new parents, and clinicians about providing expanded content for the TELL Tool that is informed by current evidence and end users, ultimately advancing best practices in this area. Future plans include testing the TELL Tool tailored to this additional developmental period o","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e79024"},"PeriodicalIF":2.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alana Fisher, Blake F Dear, Alison Dagnall, Heather D Hadjistavropoulos, Olav Nielssen, Lauren G Staples, Rony Kayrouz, Nickolai Titov
<p><strong>Background: </strong>Anxiety and depressive disorders are common and burdensome, yet many people prefer to self-manage and do not access treatment or fail to achieve meaningful improvement. Prior research indicates that the frequency of performing simple, everyday actions, namely "The Things You Do" (TYD; ie, healthy thinking, meaningful activities, having goals and plans, healthy routines, and social connection), is strongly associated with support mental health and well-being. This research has been primarily quantitative in nature, and so less is known about how people perceive and interpret changes in their mental health when engaging in or limiting these actions.</p><p><strong>Objective: </strong>This study aims to explore participants' perceptions of mental health changes and associated insights into what most impacts their mental health, during a randomized controlled trial involving the systematic restriction and followed by the resumption of the TYD actions.</p><p><strong>Methods: </strong>This longitudinal qualitative substudy analyzed weekly free-text comments from 70 healthy Australian adults (intervention group [IG] n=36; control group [CG] n=34). IG participants completed an 8-week randomized controlled trial comprising 3 phases: a 2-week baseline phase (Phase A), a 2-week behavior restriction phase during which they reduced the frequency of the TYD actions (Phase B), and a 4-week recovery or resumption phase during which they increased the frequency of the TYD actions back to usual levels (Phase C). CG participants were instructed to maintain usual habits and activities. The weekly free-text comments were related to what participants had noticed and learned about their mental health. These were thematically analyzed using framework methods to identify patterns in perceived changes, considering trial phase, group allocation, and participant characteristics.</p><p><strong>Results: </strong>Analyses identified five interrelated themes around what participants reportedly learned and what most impacted their mental health: (1) rhythms of daily life and routine, (2) harnessing internal psychological resources, (3) social support and interpersonal stressors, (4) staying active and enjoying yourself, and (5) environmental and external influences. In the IG, participants reported that behavioral restriction led to subjective disruptions across all 5 themes, precipitating declines in mood, energy, and stability; resumption fostered recovery, along with increased insights into oneself and mental health, coping strategies, and a sense of agency. Compared to the IG, the CG more often emphasized environmental and external influences.</p><p><strong>Conclusions: </strong>The findings reinforce the centrality of specific daily actions, namely the TYD, to people's subjective well-being and suggest an additional "macro-level" comprising environmental and external influences. Exposure to behavioral restriction and resumption/recovery served
{"title":"Exploring Perceived Changes to Mental Health When Restricting and Resuming Specific Adaptive Daily Actions: Longitudinal Qualitative Substudy Within a Randomized Controlled Trial.","authors":"Alana Fisher, Blake F Dear, Alison Dagnall, Heather D Hadjistavropoulos, Olav Nielssen, Lauren G Staples, Rony Kayrouz, Nickolai Titov","doi":"10.2196/82986","DOIUrl":"10.2196/82986","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and depressive disorders are common and burdensome, yet many people prefer to self-manage and do not access treatment or fail to achieve meaningful improvement. Prior research indicates that the frequency of performing simple, everyday actions, namely \"The Things You Do\" (TYD; ie, healthy thinking, meaningful activities, having goals and plans, healthy routines, and social connection), is strongly associated with support mental health and well-being. This research has been primarily quantitative in nature, and so less is known about how people perceive and interpret changes in their mental health when engaging in or limiting these actions.</p><p><strong>Objective: </strong>This study aims to explore participants' perceptions of mental health changes and associated insights into what most impacts their mental health, during a randomized controlled trial involving the systematic restriction and followed by the resumption of the TYD actions.</p><p><strong>Methods: </strong>This longitudinal qualitative substudy analyzed weekly free-text comments from 70 healthy Australian adults (intervention group [IG] n=36; control group [CG] n=34). IG participants completed an 8-week randomized controlled trial comprising 3 phases: a 2-week baseline phase (Phase A), a 2-week behavior restriction phase during which they reduced the frequency of the TYD actions (Phase B), and a 4-week recovery or resumption phase during which they increased the frequency of the TYD actions back to usual levels (Phase C). CG participants were instructed to maintain usual habits and activities. The weekly free-text comments were related to what participants had noticed and learned about their mental health. These were thematically analyzed using framework methods to identify patterns in perceived changes, considering trial phase, group allocation, and participant characteristics.</p><p><strong>Results: </strong>Analyses identified five interrelated themes around what participants reportedly learned and what most impacted their mental health: (1) rhythms of daily life and routine, (2) harnessing internal psychological resources, (3) social support and interpersonal stressors, (4) staying active and enjoying yourself, and (5) environmental and external influences. In the IG, participants reported that behavioral restriction led to subjective disruptions across all 5 themes, precipitating declines in mood, energy, and stability; resumption fostered recovery, along with increased insights into oneself and mental health, coping strategies, and a sense of agency. Compared to the IG, the CG more often emphasized environmental and external influences.</p><p><strong>Conclusions: </strong>The findings reinforce the centrality of specific daily actions, namely the TYD, to people's subjective well-being and suggest an additional \"macro-level\" comprising environmental and external influences. Exposure to behavioral restriction and resumption/recovery served","PeriodicalId":14841,"journal":{"name":"JMIR Formative Research","volume":"10 ","pages":"e82986"},"PeriodicalIF":2.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Morgan Taylor Blind, Nicola Starkey, Amy Bird, Hoana McMillan
<p><strong>Background: </strong>Globally, we face a significant treatment gap in mental health care, with extensive wait times, exorbitant prices, and concerns about appropriateness for non-Western clients. Digital single-session interventions (SSIs) may offer a promising alternative. SSIs target particular mechanisms that underlie broad-ranging psychopathology, including deficits in problem-solving skills.</p><p><strong>Objective: </strong>Developed in the United States, Project SOLVE is a digital SSI that teaches problem-solving skills to adolescents. This study evaluated the acceptability, appropriateness, and utility of an adapted version, Project SOLVE-NZ, among rangatahi (young people) in Aotearoa New Zealand. Additionally, we evaluated a comparable online activity, Project Success-NZ, as a potential active control condition in a future randomized controlled trial of Project SOLVE-NZ.</p><p><strong>Methods: </strong>A sample of school students and teachers completed Project SOLVE-NZ and Project Success-NZ. Feedback on the interventions was collected through focus groups and semistructured interviews. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>In total, 12 students (aged between 13 and 14 years; female students: n=6, 50%) participated in a focus group, and 8 teachers (teaching experience: mean 8.75, SD 7.96 years; female teachers: n=5, 62.5%) participated in individual interviews. Participants endorsed the sociocultural relevance of Project SOLVE-NZ and Project Success-NZ to rangatahi in Aotearoa New Zealand and viewed all existing adaptations favorably. Participants felt that the interventions would be valuable to a wide range of rangatahi, helping to fill gaps in students' learning and providing benefits to mental health. Participants also believed that the interventions may be particularly relevant for youths experiencing economic hardship. Interestingly, most participants had no preference for either Project SOLVE-NZ or Project Success-NZ, and they believed that both interventions could provide ongoing support to rangatahi throughout the school year. Teachers provided some suggestions on increasing student engagement with the interventions, namely, through increased cultural and gender representation, visual and literacy aids, whakawhanaungatanga (relationship building), and teacher guidance. Overall, interviews revealed that both interventions were perceived as acceptable, appropriate, and useful for rangatahi in New Zealand and highlighted further adaptations that could be made prior to a randomized controlled trial of Project SOLVE-NZ across schools nationwide.</p><p><strong>Conclusions: </strong>Digital SSIs show promise in addressing the mental health treatment gap for adolescents. Both Project SOLVE-NZ and Project Success-NZ were well-received by students and teachers in Aotearoa New Zealand and may provide benefits to youth mental health. We make the follo
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